Predictors and impact of intensification of antihyperglycemic therapy in type 2 diabetes: translating research into action for diabetes (TRIAD).

Abstract

OBJECTIVE:

The purpose of this study was to examine the predictors of intensification of antihyperglycemic therapy in patients with type 2 diabetes; its impact on A1C, body weight, symptoms of anxiety/depression, and health status; and patient characteristics associated with improvement in A1C.

RESEARCH DESIGN AND METHODS:

We analyzed survey, medical record, and health plan administrative data collected in Translating Research into Action for Diabetes (TRIAD). We examined patients who were using diet/exercise or oral antihyperglycemic medications at baseline, had A1C >7.2%, and stayed with the same therapy or intensified therapy (initiated or increased the number of classes of oral antihyperglycemic medications or began insulin) over 18 months.

RESULTS:

Of 1,093 patients, 520 intensified therapy with oral medications or insulin. Patients intensifying therapy were aged 58 +/- 12 years, had diabetes duration of 11 +/- 9 years, and had A1C of 9.1 +/- 1.5%. Younger age and higher A1C were associated with therapy intensification. Compared with patients who did not intensify therapy, those who intensified therapy experienced a 0.49% reduction in A1C (P < 0.0001), a 3-pound increase in weight (P = 0.003), and no change in anxiety/depression (P = 0.5) or health status (P = 0.2). Among those who intensified therapy, improvement in A1C was associated with higher baseline A1C, older age, black race/ethnicity, lower income, and more physician visits.

CONCLUSIONS:

Treatment intensification improved glycemic control with no worsening of anxiety/depression or health status, especially in elderly, lower-income, and minority patients with type 2 diabetes. Interventions are needed to overcome clinical inertia when patients might benefit from treatment intensification and improved glycemic control.

• Authors: Laura N McEwen, Dori Bilik, Susan L Johnson, Jeffrey B Halter, Andrew J Karter, Carol M Mangione, Usha Subramanian, Beth Waitzfelder, Jesse C Crosson, William H Herman
• Journal: Diabetes care (Diabetes Care) Vol. 32 Issue 6 Pg. 971-6 (Jun 2009) ISSN: 1935-5548 [Electronic] United States
• PMID: 19228862 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents

Topics

• Age of Onset
• Aged
• Anxiety (epidemiology)
• Depression (epidemiology)
• Diabetes Mellitus, Type 2 (drug therapy, psychology)
• Dose-Response Relationship, Drug
• Glycated Hemoglobin (drug effects, metabolism)
• Health Status
• Humans
• Hypoglycemic Agents (therapeutic use)
• Middle Aged
• Retrospective Studies
• Treatment Outcome